Left colectomy for diverticular disease - systematic review and meta-analysis comparing robotic and laparoscopic resections

Abstract

Backgroud: Diverticular disease affects approximately 50% of the population aged ≥ 60 and above. Twenty-five % will require surgical intervention. We aimed to compare the outcomes of left colonic resectionfor sigmoid diverticular disease by robotic and laparoscopic approaches. Our primary aim was to conduct a meta-analysis and to investigate conversion to open, stoma and complication rates between the two approaches. Methodology: A systematic review was performed according to the PRISMA guidelines. A meta-analysis was conducted using RevMan Version 5.4 software. Dichotomous outcomes were pooled with a random-effect model to estimate risk and odds ratios (OR). Prospero (reg # CRD42023440509). Results: Eight studies were thought to fulfil the eligibility criteria: 1,892 patients (49.2%) had robotic surgery, and 1,952 patients (50.84%) underwent a laparoscopic approach. There were fewer conversions to open surgery in the robotic group when compared to the laparoscopic group, [P < 0.00001] less rate of post-operative ileus [P = 0.005], less length of stay [mean difference (MD) - 0.18 P = 0.003] and fewer morbidities [P = 0.002]. There were similar rates of stoma formation [4.7%, P = 1.00], anastomotic leak [2.6% P = 0.85] and mortality [0.3% versus 0.2%, P = 0.59]. Although not significant, a shorter operative time in the robotic approach [P = 0.47]. Conclusion: Compared to laparoscopic left colectomy, robotic surgery is feasible, with a reduction in conversion to open rate, reduced morbidity, less ileus and similar rates of stoma formation, anastomotic leak and mortality. Further high-quality research needs to be done to investigate this further.